Provider Demographics
NPI:1912909219
Name:CARR, DOUGLAS B (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:B
Last Name:CARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-0188
Mailing Address - Country:US
Mailing Address - Phone:740-773-4366
Mailing Address - Fax:740-775-7855
Practice Address - Street 1:30381 CHIEFTAIN DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-9092
Practice Address - Country:US
Practice Address - Phone:740-385-2555
Practice Address - Fax:740-380-3750
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068864C207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0161408Medicaid
OHG11524Medicare UPIN
OHCA0786833Medicare ID - Type Unspecified
2029206Medicare PIN